Mark's note: Today's guest post is a return visit by Gert Linthout, from Belgium. Gert and I were part of the same Lean healthcare study trip to Japan back in 2012. He was the co-creator of this creative video on Kaizen that I featured in this blog post. See his previous guest posts.
By Gert Linthout
A Healthcare Improvement Story That Started with Patient Flow
It was some years ago when we guided a Lean transformation project in a regional hospital. The ambition was to drastically improve patients' experience on the surgical “one-day pathway.” An in-depth patient survey and analysis of the value stream revealed that missing information for patients and long, unpredictable waiting times were the main drivers of dissatisfaction. Sub-optimal planning and system appeared to be the most important root causes. Although the problems were recognized, there was considerable resistance within the organization to changing the current way of working.
Learning from Manufacturing–Without Copying the Tools
As part of the cultural transformation, we took a group of key players (such as doctors, nurses, and managers) to a car manufacturing site. This was done not only for sightseeing but also to assemble cars as a team in a simulated work environment. We experienced and practiced the principles of teamwork, coaching, leadership, structured problem-solving, flow and pull, and quality at the source… at the assembly line.
A Simple Change at the Gemba That Transformed Patient Waiting
It was some weeks later, during the analysis phase, while measuring baseline waiting times, that we observed a sharp (and unexpected) decrease in waiting times for a specific patient group (those undergoing small treatments with local anesthesia).
Without notifying anyone, one of the doctors present at the training had changed his approach to planning: instead of asking all patients to come at the start of his treatment block, he now called the next patient each time a patient left the treatment room (with a buffer of 2). He, in fact, translated what he had experienced at the car plant into a ‘pull' system for his patients… Waiting times dropped from 120 to 30 minutes, and patient complaints dropped to zero.
“We Are Not Toyota”: A Common Healthcare Objection to Lean
This is not someone shouting; it is the name of a recently published book (only available in Dutch). Two weeks ago, while attending the European Shingo Summit in Cork, a similar title of a healthcare presentation caught my eye. It must be a new hype, I thought, feeling quite curious, as I would find it odd to present myself as “Hi, I am not Bart.”
What would the speaker actually mean? We are not car manufacturers? We are not Japanese? We use different tools?
It was, in fact, a quite inspiring talk on how the healthcare sector has a huge potential to benefit from insights from other sectors, stressing the importance of leadership, focus on the patient and his/her individual needs, quality… and of course: “don't copy the Toyota tools blindly!”
What Toyota Actually Teaches (and What It Never Claimed)
Wondering who had suggested this in the first place, some desk research of known literature showed me no suggestions in this direction.
The focus is and always has been the creation of value, respecting individuals and developing them, pursuing a long-term purpose, extreme focus on quality… It can be brought together as a carefully designed culture, a set of desired behaviors supported by an appropriate leadership style and strong guiding principles.
Might this be what went wrong in the “Western” translation of what Toyota did: that, as a culture, is difficult to grasp and transpose to your own organization, we tried to copy the tools?
It reminds me of the Japan Kaikaku Experience together with Mark Graban, @leanmicro, and @tdgroote in 2012. At the start of the gemba tour, at the Toyota Motor Corporation Motomachi plant, the guide advised us:
The Lesson from Toyota's Gemba: Principles Before Tools
“Please do look beneath the visuals and tools you will see everywhere: they are only the result of our problem solving process, to find the answer for a specific problem we experienced at a specific moment in time. The true essence is in the underlying behaviors and principles.”
From “We Are Not Toyota” to “Proud to Be Ourselves”
What This Means for Healthcare Leaders Today
Coming back to the example of the surgeon, it gives me a great feeling: there are always more reasons not to change, yet he found one reason to do so by “going to the gemba,” trying to grasp the essence and to find a practical solution to satisfy his patients in the context of his hospital, fitting in their culture.
Instead of a “we are not…” position, I want to strike a blow for a “proud to be…” attitude. Let us start with what we are strong at, proud of, the values we muster, and the purpose we pursue. And let us continuously be inspired and learn from each other.
A Question Worth Asking in Every Hospital
What are YOU proud of?
I will go first: I am Gert, and I am proud to be Möbius. I am proud of the touchdown results together with our customers and their customers. I am proud of our perseverance every day, our endless shoulder-to-shoulder mentality, and our guts to take every opportunity to try something new!
And yes, we learn every day from our customers and partners. And yes, we learned a lot from Toyota.
Gert is inspired by the ideal of continuous improvement and is an ‘extreme' value-added thinker. Since 2003, he has brought his conviction into practice as a management consultant at http://www.mobius.eu/en/.
Editor's Note (2026):
This guest post from 2015 remains especially relevant for healthcare organizations today. Nearly a decade later, hospitals and clinics still say “we are not Toyota” as a way to dismiss Lean thinking–often while struggling with patient waiting, flow breakdowns, staff frustration, and preventable harm. As this story shows, the real lesson from Toyota was never about copying manufacturing tools. It's about designing systems that respect clinicians and staff, improve patient flow, and solve problems where the work happens. In healthcare, that mindset shift–not the tools–is still the hardest part.
If you’re working to build a culture where people feel safe to speak up, solve problems, and improve every day, I’d be glad to help. Let’s talk about how to strengthen Psychological Safety and Continuous Improvement in your organization.
Loved it! Great post. Not the first time I have heard the ‘we are not making widgets’ comment in the context of services. It seems to be difficult for some to transpose the thinking and tools to their line of work. Glad to see it wasn’t so tough for the MD to apply queuing theory to his job so quickly. Great share.
thanks, Vivienne!
Hey, I wrote the book “We are not TOYOTA, everybody on the road towards Lean Agility” in Dutch and working on an English version. The reason for the title is that in my role als a Lean sensei, I have often encountered company Managers wiping ‘lean’ off the table referring that they are not TOYOTA once they found out that the origins of Lean are TPS coming from the automotive sector, in casu TOYOTA. Quite too often I had to point out with all too many convincing arguments that Lean and Lean Kata can be applied anywhere by anybody in any situation. Some believed me, some didn’t. But every time we went for it, I proved to them to be right: Every organisation can benefit from applying the basic principles of continuous improvement with respect to people and make it part of the company’s culture. That is why I found it so necessary to write a book about it, filled with illustrations of my personal experience as a Lean coach for over 30 years. Time to get an English version on the shelves! Thank you Gert for quoting the book.L
Luc – It’s great to hear about your book. Good luck on the English version.
Let me know if you’d want to perhaps contribute a chapter to this collaborative eBook project:
https://leanpub.com/practicinglean
It’s about people’s reflections on their first year (or so) with Lean, mistakes made, lessons learned, etc.
Mark